Legionella Found in Home Infant Formula Device: What Went Wrong

[00:00:00] You might not realize it, but we are exposed to dozens of hazards every day. Can any of these hazards negatively impact your health? Definitely. This is the Exposure Scientist Podcast. My name is Alex LeBeau, and here we answer your questions and concerns on what you may be exposed to every day. Welcome

[00:00:21] to the Exposure Scientist Podcast. Hello and welcome to today's episode of the Exposure Scientist Podcast. I have a hot off the press, I'll say MMWR, Morbidity and Mortality Weekly Report from CDC. It's a note from the field. I thought it was an interesting one. It's a case of Legionnaires

[00:00:46] disease associated with a home device used for mixing powdered infant formulas. Actually a 10-month-old infant that they are attributing to this device where they'll, they in front, there was reportedly get to Legionella, Legionnaires' disease from. So it's caught my eye. If you're not familiar, the majority of the time children are not, I'll say, unless there are other issues,

[00:01:17] that immunocompromise or whatever, they are not at risk for developing Legionnaires disease. It's usually, I'll say adults that are at that risk. So for example, when you see something that's like a school that has a test positive for Legionnaires disease, the primary risk are going to be the teachers working there. The younger students are just not at risk. We don't really see that data unless

[00:01:42] there are, I'll say, some problems that are caused by immunocompromise or any other comorbidities that the individuals may have. That puts them at higher risk. This was an interesting one. Again, I think there's a lot of data that's missing. It appears this happened at a facility. It says at Georgetown University Hospital, it is in Baltimore, Maryland, or the Maryland area, that the, they found,

[00:02:09] I'll say, well, there's a lot of interesting parts here. Again, there's, there's not a lot of information because it's a note from the field. They did a test, found that the, the infant was positive under UAT for Legionella for, and they determined it was positive on UAT, which is LP1, Legionella pneumophilus here at group one. They did testing. I'll say, here's where it gets a little,

[00:02:36] a lot of information that's missing. They did testing at, I guess, the healthcare facility, but it wasn't really clear on what they tested at the healthcare facility. They did some testing at the home. It wasn't clear what they ruled out. I will say what they did. So here, they said that they,

[00:02:56] they tested the water at the home. The water, the, the kitchen faucet was positive for LP1. It said 0.7 to 3 CFU per mLs. The device, which I guess is a device that stores water inside of it and then heats it up to a certain temperature to mix it with this formula for the infant. The device was found to have LP1 at 72

[00:03:25] 0.5 CFU per mL. This was, I just said, under traditional spread plate culture. I'm just presuming it's just the culture method that's like the ISO method or CDC method. They don't specify. What's interesting here is that, well, there's a lot of missing information. There's a lot of information that I'll say that the, that was probably not followed correctly. It said, although

[00:03:53] routine water testing on in the, I'll say approximately 10 days before this individual was hospitalized, um, for, I guess another issue, um, that they did not detect Legionella or then there were no abnormal chlorine values. I don't know what abnormal chlorine values mean, maybe out of spec, non-detect. It does not clear. What caught my eye also then, because then 10 month

[00:04:18] old infant, but you know, it's the, the field note says no additional aerosol generating exposures, example, humidifiers or showers were identified at the home or the healthcare facility. So the kid didn't get a bath anywhere. They weren't around any other aerosolized

[00:04:45] source at the home. It's, it's not very clear because I mean, I've got kids. I remember giving my kids baths. I mean, even when you're turning on some water, whether it's a sink bath or something in the tub, there's, I mean, water is going to be coming out of the faucet. It's not going to be to the extent that it would be in a shower head. Uh, but it's, it's a water source that has a potential

[00:05:10] exposure. Now I think that the presumptive pathway that they're getting to is aspiration or aspirational in this, um, in this methodology they've employed. I, I suggest you go check this out. It says June 18th for this MMWR. It says case of Legionnaires disease associated with a home device

[00:05:37] used for mixed powder infant formula in the United States from 2025. I should clarify that's from 2025. Go read it and see if you have some questions. Um, there's a lot that's, I'll say there's a lot of details that are not here, uh, that are helpful. Now, again, this is notes from the field. This is one where you're like, well, not all the information is here. So we really can't,

[00:06:00] um, say that it doesn't exist because these are supposed to be quick notes, quick things from the field. Now, what an interesting thing here, and this goes for a lot of devices, especially I'll say something that would be a, a, a quote unquote medical device is that they, the first of all, there was a, they claimed that there was a filter on the kitchen sink that was used to remove chlorine.

[00:06:27] Okay. That catches my eye. They said they didn't test the filter. They didn't identify whether or not the filter had Legionella bacteria in it. They did detect it in the kitchen sink faucet, which again is an aerating device. So there's faucets all over the house, but that's another story. What is interesting here is that it, and again, it appears that they used

[00:06:55] the kitchen sink water for this device. And within this document, let me go down here. I think it said, it says the, and here's where it gets me. And let me just click on this link just to make sure, because I went there individually myself. It says the manufacturer recommends using distilled or

[00:07:20] boiled water, but does not specifically recommend routine internal reservoir draining. Now I get that. I get this interesting aspect of this, but if you go to the instructions, it says, attention, follow these steps before doing anything else. Fill water tank with bottled water suitable for infant

[00:07:43] formula preparation or boiled water cooled to room temperature. I don't think that's a recommendation. I think it says, this is how you use this. I think that's a kind of saying, well, you know, we're, we're, we're kind of kind of, eh, we're, we're not going to hold them too responsible. Maybe, you know, they, they just didn't fully understand it. It literally says here in the instructions.

[00:08:13] And typically when you do water in these devices, you want something that's suitable for the device that's maybe undergone some type of pasteurization process. Um, and there is a monthly, I'll say, quote unquote, descaling instructions that you're supposed to do monthly. So the manufacturer, I don't think, I mean, when it's kind of like with, with, with other devices, you know,

[00:08:39] when the view, and then I'm not making this, this, um, this method to match up what ASHRAE 188 is, uh, in comparison to, I'll say these medical devices, but you know, and 188 says, hey, building owner operator, you're responsible. When you have a medical device, I mean, there's sort of responsibility to sit here and follow the instructions. Now, if there's somewhere

[00:09:04] else in here, it says, well, it doesn't matter. I, I, I'm not seeing it. Um, but it is, it's just interesting, you know? Yeah. If you're, it says the, the vice water was, heats it up to 106 degrees. Sure. Yeah. Yeah. It's probably something this, especially if it's an incoming water and I've done work in Baltimore, Baltimore or Baltimore waters. There's some issues with some water up there that

[00:09:30] we found in past instances. So to say that, you know, it's, it's not unsurprising that they found it within utility supplied water. Is this something that is, is going to be a problem for device manufacturers? You know, at what point do you have, do you let the hand go of the owner of the device and go, okay, well, we've given you everything we've can. We've told you how to use this in the

[00:09:56] instructions. So I feel bad for this kid, uh, getting Legionnaires disease. And again, it's not typical. It makes somewhat sense for the aspiration method, especially from, you know, if there's a medical problem with the individual already, um, having kids, uh, that, you know, my own that were, the age one time, um, that like to vomit quite often. Um, so it, it makes sense because again,

[00:10:26] typically you're not concerned with, I'll say inhalation at that young age, but again, there's other medical problems. So I don't think you can totally rule out other aerosol generating devices, but to say that there's no other aerosol exposures in the home, uh, that's, that's a big gap there. That's a big, well, I'm not sure how much I, you know, give me a schematic, give me the information, how many faucets, what was the hot water heater at that information's out there. I'm presuming they

[00:10:55] just use cold water. Did they test the hot water system? They just tested the sink. They didn't even say it was hot, cold, lots of questions, which is why when you're doing these assessments, and again, this is, it appears from, from what I've seen, this is a, um, department of health, uh, in some part, department of health, uh, conducting this information as well as others in the hospital system or healthcare system and CDC. You need to have familiarity with doing these assessments,

[00:11:24] what information needs to be gathered, um, what you should be looking for, you know, they, and actually they're, you know, again, they were, they were hospitalized. They would have outplayed, out clinic visits, um, outpatient clinic visits, sorry. Um, what else for the exposures? Now that's a, that's a big one, you know, that it was in the device, but if you're not using the device properly

[00:11:51] and you're putting untreated essentially water into a device that's specified to have a specific type of water in there, that's a, that's a, at some point you, you've got to say, you know what, there's, there's an improper use here. We can only hold your hand so far. I just thought this was interesting. It came along, I know we're talking about doing some stuff from

[00:12:17] evaluating some of the bigger outbreaks, um, of Legionella and Legionnaire's disease for the past couple of years. As I mentioned on that podcast recently, that the majority of Legionnaires' disease, uh, instances are individual cases. They're just cases that are out there and they're just random spots. This is one of them. This is not a series. This is not an outbreak. This is just a case.

[00:12:45] So it goes to the fact that their outbreaks are, are not as common as you think they are. Majority of these are individual cases. So I thought this, again, this caught my eye. I wanted to get, at least get that out there, get that information, take a look, field notes. I'm presuming there'll be more information, uh, on this, but find out, uh, take a look at it. Let us know what you think. If you have any feedback, I'm happy to have a discussion with you as always. I hope you got something out of this podcast and I hope to talk to you in the next one soon. Thanks so much.

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